US11751890B2 - Drilling platform tool for surgeries - Google Patents
Drilling platform tool for surgeries Download PDFInfo
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- US11751890B2 US11751890B2 US16/651,202 US201816651202A US11751890B2 US 11751890 B2 US11751890 B2 US 11751890B2 US 201816651202 A US201816651202 A US 201816651202A US 11751890 B2 US11751890 B2 US 11751890B2
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1771—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the ear
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1703—Guides or aligning means for drills, mills, pins or wires using imaging means, e.g. by X-rays
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
- A61N1/0526—Head electrodes
- A61N1/0541—Cochlear electrodes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
- A61B1/05—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances characterised by the image sensor, e.g. camera, being in the distal end portion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
- A61B2017/3405—Needle locating or guiding means using mechanical guide means
- A61B2017/3407—Needle locating or guiding means using mechanical guide means including a base for support on the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B2017/568—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor produced with shape and dimensions specific for an individual patient
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
- A61B2034/108—Computer aided selection or customisation of medical implants or cutting guides
Definitions
- the present invention relates to a surgical tool and methodology for guiding surgical instruments, and more particularly, to a drilling platform tool that provides a well-defined drilling or cutting path.
- a normal ear transmits sounds as shown in FIG. 1 through the outer ear 101 to the tympanic membrane (eardrum) 102 , which moves the bones of the middle ear 103 (malleus, incus, and stapes), which in turn vibrate the oval window and round window openings of the cochlea 104 .
- the cochlea 104 is a long narrow duct wound spirally about its axis for approximately two and a half turns.
- the cochlea 104 includes an upper channel known as the scala vestibuli and a lower channel known as the scala tympani, which are connected by the cochlear duct.
- the scala tympani forms an upright spiraling cone with a center called the modiolar where the spiral ganglion cells of the acoustic nerve 113 reside.
- the fluid-filled cochlea 104 functions as a transducer to generate electric pulses that are transmitted to the cochlear nerve 113 , and ultimately to the brain.
- a cochlear implant is an auditory prosthesis which uses an implanted stimulation electrode to bypass the acoustic transducing mechanism of the ear and instead stimulate auditory nerve tissue directly with small currents delivered by multiple electrode contacts distributed along the electrode.
- FIG. 1 also shows some components of a typical cochlear implant system which includes an external microphone that provides an audio signal input to an external signal processing stage 111 where various signal processing schemes can be implemented.
- the processed signal is then converted into a digital data format, such as a sequence of data frames, for transmission into the implant stimulator 108 .
- the implant stimulator 108 also performs additional signal processing such as error correction, pulse formation, etc., and produces a stimulation pattern (based on the extracted audio information) that is sent through connected wires 109 to an electrode array 110 inserted into the cochlea.
- this electrode array 110 includes multiple electrode contacts on its surface that provide selective stimulation of the cochlea 104 . Stimulation is either carried out against an external reference electrode contact (i.e., a remote ground contact) outside the cochlea or against another electrode contact of the array within the cochlea 104 .
- the insertion of the electrode array 110 often includes making an incision behind the ear, and using a drill to then enter the middle ear.
- the electrode array 110 is placed through an opening created in the cochlea 104 , and the implant stimulator 108 is then placed into a pocket under the skin on the skull behind the ear.
- U.S. Pat. No. 7,981,122 to Labadie et al. discloses various surgical guide tools that include a guide platform having legs of adjustable lengths that rest on a body part.
- the assembly and adjustment of the positioning of the legs on the body part can be time-consuming and expensive.
- WO2016/198032 proposes a positioning aid with legs that cannot be changed in length.
- the guide plate in WO2016/198032 is manufactured for each patient according to produced pre-operative images, whereas the other components of the system may be reusable.
- the calculated optimal drilling trajectory is enabled by providing a guide plate having a center and an axis perpendicular to the surface of the plate and through which a trajectory may be drilled off-center and under a certain angle to the axis. This may not be optimal, as the surgeon may thus have to move a drill oriented at an angle other than perpendicular from the surface of the plate.
- a surgical guide tool includes a non patient-specific platform including one or more supports for attaching to a body part of a subject.
- a non patient-specific block has a top planar surface and a bottom planar surface, and includes a guide aperture extending from the top planar surface to the bottom planar surface for guiding a surgical instrument in making at least one of a cut and a drill hole.
- An intermediate module is removably positioned between the platform and the block. The intermediate module has patient-specific dimensions such that the guide aperture has a desired alignment relative to the body part when the surgical guide tool is attached to the body part of the patient and the intermediate module is positioned between the platform and the block.
- the guide aperture may be a borehole defining an axis through the block.
- the axis may be perpendicular to both the top and bottom planar surfaces of the block.
- the intermediate module may have a top module surface for positioning adjacent the block, and a bottom module surface for positioning adjacent the platform, the intermediate module having a varying height between the top surface and the bottom surface such that the guide aperture has a desired alignment relative to the body part when the surgical guide tool is attached to the body part of the patient.
- the top module surface and the bottom module surface may be planar and non-parallel.
- the supports of the platform may include legs that are fixed and immobile relative to the platform, the legs having non-adjustable dimensions.
- Both the intermediate module and the platform may be configured so that they do not block the aperture in the block when the intermediate module is positioned between the platform and the block.
- the block may be braced to the platform such that there is no freedom of play in one or more dimensions.
- the surgical tool may further include a clamp, for clamping the platform, block and/or intermediate module to each other.
- the platform, block and/or intermediate module may include one of an elevation, a recess, a pin, and/or a pin receptacle, to ensure proper positioning relative to each other.
- a method in accordance with another embodiment of the invention includes providing a non patient-specific platform for attaching to a body part of a subject.
- a non patient-specific block is provided having a top planar surface and a bottom planar surface, the block including a guide aperture extending from the top planar surface to the bottom planar surface for guiding a surgical instrument.
- Electronic image data is obtained of an anatomical area of the subject.
- a trajectory for at least one of a cut and a drill hole is determined based, at least in part, on the electronic image data.
- An intermediate module is provided that is configured to be removably positioned between the platform and the block, the intermediate module having patient-specific dimensions such that the guide aperture in the block is configured to guide the surgical instrument in making the at least one of a cut and drill hole along the determined trajectory when the platform is attached to the body part of the patient and the intermediate module is sandwiched between the platform and the block.
- obtaining the electronic image data may include one of pre-operatively, intraoperatively, optically, an Mill, a CT and a spiral CT, or combinations thereof.
- the method may further include mounting the platform on the body part, with the intermediate module sandwiched between the platform and the block, and using the guide aperture to make at least one of a cut and a drill hole into the body part.
- the body part may be the skull, wherein the platform is mounted on the skull, and wherein the guide aperture is used in guiding a surgical instrument to drill a hole through the skull into the middle ear, the method further including inserting an electrode array of a cochlear implant into the hole.
- the intermediate module may have a top module surface for positioning adjacent the block, and a bottom module surface for positioning adjacent the platform, the intermediate module having a varying height between the top surface and the bottom surface such that the guide aperture has the desired alignment relative to the body part when the surgical guide tool is attached to the body part of the patient and the intermediate module is positioned between the platform and the block.
- the top module surface and the bottom module surface may be planar and non-parallel.
- the guide aperture may be a borehole defining an axis through the block.
- the axis may be perpendicular to both the top and bottom planar surfaces of the block.
- the platform may include legs for attaching to the body part, the legs being fixed and immobile relative to the platform, the legs having fixed dimensions that cannot be varied. Both the intermediate module and the platform do not block the aperture in the block when the intermediate module is sandwiched between the platform and the block.
- Providing the intermediate module may include cutting, drilling, milling, and/or laser sintering a blank of material.
- a surgical guide tool in accordance with another embodiment of the invention, includes a non patient-specific platform including one or more supports for attaching to a body part of a subject.
- a patient-specific block has a top surface and a bottom surface, the block including a guide aperture extending from the top surface to the bottom surface for guiding a surgical instrument in a making at least one of a cut and a drill hole.
- the block has patient-specific dimensions such that the guide aperture has a desired alignment relative to the body part when the surgical guide tool is attached to the body part of the patient and the block is braced against the platform.
- the top surface and the bottom surface of the block are planar and non-parallel.
- the guide aperture may be a bore hole defining an axis through the block.
- There may be a non patient-specific, predefined arrangement between the axis and the top surface of the block.
- the axis may be perpendicular to the top surface of the block.
- the supports of the platform include non patient-specific legs that are fixed and immobile relative to the platform, the legs having non-adjustable dimensions.
- the surgical tool may include a clamp for clamping the block to the platform.
- the block and/or platform may include an elevation, a recess, a pin, and/or a pin receptacle, to ensure proper positioning of the block relative to the platform.
- a method includes providing a non patient-specific platform for attaching to a body part of a subject.
- Electronic image data is obtained of an anatomical area of the subject.
- a trajectory for making at least one of a cut and a drill hole is determined based, at least in part, on the electronic image data.
- a patient-specific block is provided having a top surface and a bottom surface, the block including a guide aperture extending from the top surface to the bottom surface for guiding a surgical instrument in making at least one of a cut and a drill hole.
- the top surface and the bottom surface of the block are planar and non-parallel.
- obtaining the electronic image data may include one of pre-operatively, intraoperatively, optically, an Mill, a CT and a spiral CT, or combinations thereof.
- the method may further include mounting the platform on the body part, with the block braced against the platform.
- the guide aperture is used to make at least one of a cut and a drill hole into the body part.
- the body part may be the skull, wherein the platform is mounted on the skull, and wherein the guide aperture is used in guiding a surgical instrument to drill a hole through the skull into the middle ear, the method further including inserting an electrode array of a cochlear implant into the hole.
- the block may be braced to the platform such that there is no freedom of play in one or more dimensions.
- the guide aperture may be a bore hole defining an axis through the block.
- There may be a non patient-specific, predefined arrangement between the axis and the top surface of the block.
- the axis may be perpendicular to the top surface of the block.
- the platform may include non patient-specific legs for attaching to the body part, the legs being fixed and immobile relative to the platform, the legs having fixed dimensions that cannot be varied.
- Providing the block may include cutting, drilling, milling, and/or laser sintering a blank of material.
- the block may be clamped to the platform.
- the block and/or platform may include one of an elevation, a recess, a pin, and a pin receptacle, or combinations thereof, to ensure proper positioning of the block relative to the platform.
- the surgical guide tool may include a guiding element that may be attached or integral with the block.
- the guiding element may have guiding walls, with, for example, rollers operatively coupled to the guiding walls.
- the surgical instrument contacts the rollers to ensure that the surgical instrument moves through the guide aperture without tilt.
- FIG. 1 shows various anatomical structures of the human ear and components of a typical cochlear implant system in relation thereto;
- FIG. 2 shows a composite view of a surgical guide tool, in accordance with an embodiment of the invention
- FIG. 3 shows an exploded view of the surgical guide tool depicted in FIG. 2 ;
- FIG. 4 A shows a top view of a platform in accordance with an embodiment of the invention, while FIG. 4 B shows a side view of the platform;
- FIG. 5 A shows a top view of the intermediate module 203 , in accordance with an embodiment of the invention, while FIG. 5 B shows a side view of the intermediate module 203 ;
- FIG. 6 is a flowchart chart illustrating a methodology that includes manufacturing an intermediate module, and further includes performing a medical procedure, in accordance with an embodiment of the invention
- FIG. 7 shows lateral offsets y and z between the platform and intermediate module, in accordance with an embodiment of the invention.
- FIGS. 8 A (top view) and 8 B (side view) show a patient specific block of a surgical guidance tool that does not have intermediate module, in accordance with an embodiment of the invention.
- FIG. 9 shows a guiding element, in accordance with an embodiment of the invention.
- a surgical guide tool and methodology for guiding a surgical instrument in making a cut and/or drill holes in a body of a subject is provided.
- the surgical guide tool may be used when drilling into the skull of a patient, and more particularly, to drill a hole in the middle ear facilitating insertion of an electrode array of a cochlear implant.
- the provided surgical tool and methodology is not limited to the skull, and may also be applied to other parts of the body. Details hereto are described below.
- FIG. 2 shows a composite view of a surgical guide tool 200 , in accordance with an embodiment of the invention.
- FIG. 3 shows an exploded view of the surgical guide tool 200 depicted in FIG. 2 .
- the surgical guide tool 200 includes a non patient-specific platform 201 having a plate 210 .
- One or more supports 211 may be fixed to the plate 210 , the support(s) 211 for attaching to a body part 250 of a subject.
- the support(s) 211 may include, without limitation, one or more legs 211 .
- the legs 211 may have fixed dimensions and shape that cannot be varied.
- the leg 211 may be integral with the plate 210 , or attached at one end to the plate 210 with, for example, screws or welds, such that they are fixed and immobile relative to the platform 201 .
- the other end of each leg 211 serves to rest on the body part, and may include various attachment mechanisms 212 known in the art, such as screws or pins, for fixing the legs, and hence the platform 201 , to the body part 250 .
- FIG. 4 A shows a top view of the platform 201
- FIG. 4 B shows a side view of the platform 201 , in accordance with an embodiment of the invention.
- the platform 201 may include an opening 213 .
- the opening 213 is a cavity which leads from one side to the other of the plate 210 and may be surrounded in whole or in part by plate 210 .
- the plate 210 may have, without limitation, the shape of an L as shown in FIG. 4 A .
- the plate 210 may be circular or rectangular in form, or have other forms which support the surgical process described further below.
- Plate 210 has a top surface 214 , upon which, for example, a block may sit on, described in more detail below.
- the surgical guide tool 200 further includes a non patient-specific block 202 having a top planar surface 220 and a bottom planar surface 221 .
- the bottom surface 221 of the block 202 is closer to the body part 250 when the surgical guide tool 200 is fixed to the body part 250 , as shown in FIGS. 1 and 2 .
- the block 202 includes a guide aperture 222 extending from the top planar surface 220 to the bottom planar surface 221 for guiding a surgical instrument in making at least one of a cut and a drill hole.
- the block 202 may serve as a drilling table, with the guide aperture 222 being a borehole 222 that defines an axis 223 through the block 202 .
- the guide aperture 222 may be a borehole 222 that defines an axis 223 through the block 202 .
- the axis 223 may be perpendicular to both the top and bottom planar surfaces 220 , 221 of the block 202 . This may be advantageous for a surgeon, as it may often be easier to keep and move a drill oriented perpendicular to a surface than under other angles.
- the axis 223 may also be non-perpendicular to the top and bottom planar surfaces 220 , 221 of the block 202 .
- the non patient-specific block 202 may be manufactured independent of the body part 250 (e.g. the patient's skull) and may be reusable for many patients.
- the surgical guide tool 200 also includes an intermediate module 203 removably sandwiched between the platform 201 and the block 202 .
- the intermediate module 203 has patient-specific dimensions, customized to the patient, such that the guide aperture 222 has a desired alignment relative to the body part 250 when the surgical guide tool 200 is attached to the body part 250 of the patient and the intermediate module 203 is positioned between the platform 201 and the block 202 .
- the patient-specific intermediate module 204 will ensure that the guide aperture 222 has the proper alignment to make the cut or drill hole.
- FIG. 5 A shows a top view of the intermediate module 203
- FIG. 5 B shows a side view of the intermediate module 203
- the intermediate module 203 includes a top module surface 234 for positioning proximate and/or adjacent the block 202 , and a bottom module surface 235 for positioning proximate and/or adjacent the platform 201 .
- the top module surface 534 and the bottom module surface 535 are planar and non-parallel.
- the height between the top module surface 534 and the bottom module surface 535 may vary over the area of the intermediate module 203 , such that the guide aperture 222 has a desired alignment relative to the body part 250 when the surgical guide tool 200 is attached to the body part 250 of the patient.
- the intermediate module 203 is L formed, at least some of the heights 530 , 531 , and 532 may be different (see FIGS. 5 A and 5 B ).
- intermediate module 203 may have a different form as the plate 210 , or they may have similar forms, as exemplarily shown in FIG. 5 A , top view.
- the intermediate module 203 has an opening 233 which borders should not cover opening 213 of plate 210 when the platform 201 and intermediate module 203 are adjacent each other.
- plate 210 and intermediate module 203 may be similar, their lateral dimension may vary. This is exemplarily indicated by lengths x′ of plate 210 (see FIG. 4 A ) and x′′ of intermediate module 203 (see FIG. 5 A ). x′ may be substantially equal to x′′, however in various embodiments x′′ may also be larger than x′ for reason outlined further below. Similarly, the lengths perpendicular to x′ or x′′ may vary.
- Intermediate module 203 may be manufactured interoperatively during a medical procedure as a disposable module, or may be manufactured preoperatively. As the dimensions of the intermediate module 203 are patient-specific, it is manufactured for each patient individually and may be used just once, whereupon it may be disposed. In contrast, the platform 201 and block 202 are non patient-specific, and may be used repeatedly with various patients.
- FIG. 6 is a flowchart illustrating a methodology that includes manufacturing an intermediate module, and further includes performing a medical procedure, in accordance with an embodiment of the invention.
- the non patient-specific platform and block are provided, steps 601 and 603 .
- a surgeon may choose from a set of platforms/plates and blocks which best suit the anatomy of the patient's body part and anatomical area of interest (for example, and without limitation, the skull).
- the platform may include marker elements utilized during subsequent imaging of the patient's body part and anatomical area of interest. The marker elements may be visible on the acquired image of the patient and may be advantageous in determining the position and orientation of the platform relative to the patient's area of interest.
- Electronic image data of the patient's anatomical area of interest is obtained, step 604 .
- Obtaining the electronic image data may be done intraoperatively, or alternatively, pre-operatively.
- Obtaining the electronic image data may include an Mill, a CT and/or a spiral CT.
- the electronic image data may also be obtained optically.
- a trajectory to be cut or drilled is determined, step 605 .
- a specialized software module running on a processor may analyze the electronic image data and calculate parameters for a trajectory to be drilled.
- this may be the optimal trajectory from the patient's skull bone behind the ear into the middle ear.
- Important trajectory parameters of the trajectory may include, without limitation, its trajectory 251 (shown in FIG. 1 ) and the point where the axis crosses the surface of the skull.
- a suitable intermediate module together with its characteristic module parameters can be determined and manufactured, step 607 .
- characteristic module parameters may include, without limitation, heights 530 , 531 , and 532 , as well as lateral offsets y and z between the platform 201 and intermediate module 301 , as exemplary shown in FIG. 7 .
- the characteristic module parameters may also include lateral offsets between intermediate module and block. Referring to FIG. 2 , these offsets may be used to ensure that in the composite surgical guide tool 200 , the axis 223 of bore hole 222 in the block 202 coincides with the determined trajectory 251 .
- the intermediate module may be molded.
- the platform may be mounted on the body part, with the intermediate module sandwiched between the platform and the block, step 609 .
- a drilling platform 201 may be mounted on patient's skull bone 250 upon which the intermediate module 203 and then the drilling table 202 sits.
- the longitudinal axis 223 of the bore hole 222 coincides with the longitudinal axis of the desired and predetermined trajectory 251 into the skull bone 250 .
- the surgeon or robot may then insert a surgical instrument through the guide aperture to make the cut or drill hole, step 611 .
- the intermediate module ensures that the trajectory or the surgical instrument follows the desired trajectory.
- the longitudinal axis of the guide aperture in the non patient-specific block may be perpendicular to the surface of drilling table. This may be beneficial for the surgeon, as it may be easier to keep and move a drill oriented perpendicular to the surface of the block than under another angle.
- FIG. 4 there may be a position defining element on surface 214 of platform table 201 and/or plate 210 , as shown in FIG. 4 .
- This position defining element may be, for example, a longitudinal or punctate or conical elevation. In FIG. 4 , this is shown as longitudinal elevations in both dimensions of the plane 415 .
- An according recess may be milled in the bottom surface 235 of intermediate module 203 during manufacturing. Alternatively, the elevation is in bottom surface 235 and the recess may be on the platform 201 or plate 210 .
- An alternative solution of, or in combination with, providing elevations and recesses may be cylindrical pins extending out of platform table 201 and/or plate 210 , and/or recesses made by drilling during the medical procedure as described above.
- intermediate module 203 it may be required that intermediate module 203 is larger than plate 210 and/or block 202 in either or both dimensions of the respective surface planes such that possible shifts y and z can be realized. At least two cylindrical pins/recesses would be beneficial on each of the surfaces.
- the intermediate module 203 is manufactured intraoperatively during the medical process, it may be advantageous that the intermediate module 203 receives the recesses whereas the elevations (pins) are provided to platform 201 /plate 210 , and or block 202 .
- the surgical guidance tool described herein may be realized without an intermediate module, as shown in FIG. 8 A (top view) and FIG. 8 B (side view). To do so, various portions of the block 802 may be patient-specific to guarantee coincidence of the determined trajectory with axis 823 of guide aperture 822 .
- the patient-specific block 802 may have planar and non-parallel top and bottom surfaces with at least some of the heights 824 , 825 , 826 , and 827 assuming different values.
- the heights 824 , 825 , 826 and 827 are patient-specific to ensure that the non-patient specific, predefined arrangement between the axis 823 of the guide aperture 822 and the top surface of the block 802 provides the proper predetermined angle/trajectory.
- the axis 823 may be perpendicular to the top planar surface 820 of the block 802 .
- the axis 823 may be non-perpendicular to the top planar surface 820 .
- the bore hole 822 may be in or off the center of block 802 .
- bore hole 222 / 822 there might be a trade-off between size of bore hole 222 / 822 and precise alignment of axis 223 / 823 with trajectory 251 during the trajectory e.g. into patient's skull.
- bore hole 222 / 822 must match exactly the dimension of that part of the bore apparatus, which is moved through block 202 by the surgeon's (or a robot's) force during drilling in order to avoid an unintended angle between axis 223 / 823 and trajectory 251 .
- a guiding element may, for example, be attached to surface 220 of block 202 (alternatively, this guiding element may be integral part of block 202 ), which keeps the bore apparatus in an orientation such that axis 223 / 823 and trajectory 251 are perfectly aligned during drilling.
- FIG. 9 shows a guiding element, in accordance with an embodiment of the invention.
- the guiding element may include guiding walls 950 , with, for example, guiding rollers 951 operatively coupled to the guiding walls 950 which ensure that portion 960 of the bore apparatus moves without lateral tilt and such that axis 223 / 823 and trajectory 251 are always perfectly aligned during drilling.
- the rollers may have various shape, and generally be, without limitation, wheel shaped, circular, cylindrical or spherical in nature.
- Such guiding element of a bore apparatus can be advantageously utilized in connection with the systems shown, for example, in FIG. 2 , compared to the invention disclosed in WO2016/198032, because the entire block 202 may be manufactured non patient-specific.
- the angle of axis 223 relative to surface 220 of block 202 is independent of the patient and the guiding element can be oriented accordingly.
- the block 802 is patient-specific, the angle between surface 820 and axis 823 is non patient-specific and therefore again the guiding element can easily be oriented accordingly.
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- Radiology & Medical Imaging (AREA)
- Otolaryngology (AREA)
- Cardiology (AREA)
- Pathology (AREA)
- Surgical Instruments (AREA)
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US16/651,202 US11751890B2 (en) | 2017-10-06 | 2018-10-05 | Drilling platform tool for surgeries |
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EP (1) | EP3691513A4 (zh) |
CN (2) | CN115869039A (zh) |
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Also Published As
Publication number | Publication date |
---|---|
AU2018346706B2 (en) | 2022-02-10 |
EP3691513A1 (en) | 2020-08-12 |
CN111246790A (zh) | 2020-06-05 |
WO2019071141A1 (en) | 2019-04-11 |
US20210196289A1 (en) | 2021-07-01 |
AU2018346706A1 (en) | 2020-04-16 |
AU2022203084B2 (en) | 2023-12-07 |
WO2019071141A4 (en) | 2019-05-31 |
CN111246790B (zh) | 2023-02-17 |
EP3691513A4 (en) | 2021-06-23 |
CN115869039A (zh) | 2023-03-31 |
US20230270453A1 (en) | 2023-08-31 |
AU2022203084A1 (en) | 2022-05-26 |
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